• man shoveling snow, practicing shoveling safety

    Originally posted 3/21/2018 by Dorothy Lehr, DPT, OCS, Cert. MDT updated 2/3/2022

    Major snowstorms have a way of causing major headaches…and major muscle aches!

    Snowstorms have already hit many parts of the country this winter, with more on the way. And while there’s beauty in a landscape covered in white, there’s potential for back aches and muscle strain in the chore of removing snow if not done safely and with preparation.

    So before powering up that monster snow blower and pushing it along the sidewalks or layering up with hats, scarves and gloves, read on for tips to keep you safe and healthy while out in the bluster.

    Beware the Shovel

    • While a shovel with a standard handle may be cheaper to purchase, beware! Shovels with “bent” handles – ergonomic handles – are a better choice for reducing back strain. Choose one with a cushioned grip too.
    • Look for a shovel that also has a sharp bend in the shaft. This type of shovel is made to decrease back strain as you push and stoop to scoop.
    • The weight of the snow makes a difference in snow tool choice. Snow tool? That’s right!
      Today’s shovels have come a long way from the standard shovel and come in a range of blade features (the scooping or chiseling part) to lessen strain and injury.
      • Light and fluffy? Aluminum is the way to go.
      • Heavy and slushy? Polycarbonate, shatter-resistant gets the job done.
      • Icy and compressed? Galvanized steel chips away with lower impact.

    Tame the Technique

    Proper shoveling is just as important as the correct shovel.

    Keep your back straight.

    Bend at your hips and knees.

    Avoid twisting your body when dumping snow. Instead, pivot your legs to turn your whole body.

    Wear shoes or boots with good tread to avoid slipping on slick areas or black ice. Applying pet-friendly salt, sand or kitty litter gives traction and decreases the risk of slipping.

    Snow shoveling can be as physically demanding as a gym workout and should be treated like a day in the gym.

    Don’t overexert yourself, especially when the snow is wet and heavy. In deep snow, take a few inches off the top and tackle the job by dividing it into thirds, with one-hour rest breaks.

    Prepare and Prevent Injury

    Snow shoveling is a cardiovascular and weight-lifting exercise. So just like you need to stretch before working out or exercising to get its great benefits, stretching before and after is important.

    If you need to tackle a big snow that will take more than a few minutes, taking a break and stretching in between clearing snow or drifts will help prevent injury.

    Lumbar Extension

    This stretch helps balance in any forward-bending movement while shoveling. Choose a standing or laying position.

    woman demonstrating lumbar extension stretch

    Extension 1: Stand and bend back as far as is comfortable and hold for three to five seconds. Do 10-15 repetitions.

    woman demonstrating lumbar extension stretch

    Extension 2: Lie on your stomach and bend back as far as is comfortable and hold for three to five seconds. Do 10-15 repetitions.

    Quadriceps Stretch

    While standing, use your right arm to pull your right leg up toward your buttocks. Keep your trunk straight and use opposite arm to hold onto a sturdy object to maintain balance.

    woman demonstrating quad stretch

    Duration: Hold each stretch for 20 seconds doing five reps on each leg. This will stretch out your quad muscles that you’ll be using to lift while shoveling.

    Hip Flexor Stretch

    In a half-kneeling position and while maintaining an upright trunk, lunge forward until you feel a stretch in the front of your hip.

    woman demonstrating hip flexor stretch

    Duration: Hold position for 20 seconds doing five reps on each leg. This stretch will help to stretch the muscles you’ll be using while moving snow and helps to keep your spine in a neutral position.

    Beyond Shoveling Safety Tips

    Sometimes, there will be a winter storm where a snow shovel isn’t enough.

    While a snow blower can certainly help with snow removal, snow blower injuries and accidents do happen. Burn injuries, lacerations, fractures and even amputations are the biggest reasons for ER visits from snow blower injuries.

    "The Consumer Products Safety Commission estimates that 3,000 persons are treated in emergency rooms in the United States for snow-blower injuries each year."

    Practice these to stay safe while operating a snow blower:

    • Never put your hands down the chute or around the blades of a snow blower. If you need to clear wait 10 seconds after turning off the engine for the blades to stop spinning. Use the handle or a broom, a stick or another tool to clear any clogs.
    • Keep hands and feet clear of all moving parts of a snow blower.
    • Avoid hanging scarves and loose-fitting clothing which could become tangled in the moving parts and pull you into the machine.
    • Direct the discharge chute away from you, other people or areas where any damage can occur. The blower can throw hard objects, such as salt, sticks and ice.

    Winter can be brutal, even when you do prepare and follow safe practices.

    If you’re feeling nagging aches and pains or you’ve suffered an injury during your winter clean-ups, we’re here for you.

    Click the Contact Us button below to request an appointment with a nearby center. Stay safe and keep thinking spring – it’s coming!

    By: Dorothy Lehr, DPT, OCS, Cert. MDT. Dot is a physical therapist and center manager with NovaCare Rehabilitation in Willingboro, NJ. A treating clinician for 12 years, Dot is a board certified orthopaedic specialist and McKenzie credentialed therapist, specializing in spine treatment.


  • man with osteoarthritis in his knee

    Posted on 10/25/2021

    Did you know that knee osteoarthritis affects nearly 14 million adults in the United States1 per year? Or that meniscus tears are present in 60-90%1 of those with knee osteoarthritis? With symptoms ranging from knee pain, swelling, stiffness and limited range of motion, medication, injections, surgery and physical therapy are all commonly prescribed to manage knee pain. Medication and injections, however, may simply serve to mask your pain. Surgery can be costly and taxing on your body. Physical therapy, on the other hand, emphasizes a more holistic approach to the body with emphasis on education, pain management and strength and conditioning.

    At first glance, it can be frustrating when you are referred to physical therapy for management of knee pain related to structural issues like osteoarthritis or a knee joint tear. Is the physical therapist going to magically reverse your arthritis or heal your meniscus? Shouldn’t you address the structural problem head-on instead of just “strengthening around it?”

    Not necessarily.

    Surgery or osteoarthritis physical therapy?

    If we dig deeper, a better question to consider might be, “Do I need to change the structure of my knee in order to resume the activities I enjoy?” There are several studies to suggest that abnormal findings on X-rays and MRIs can be common, even in persons without knee pain. In fact, a 2020 study2 of a population with a median age of 44 and no knee pain found that an astounding 97% of knees had abnormalities on MRI. In addition, when comparing physical therapy management to surgical intervention, there are many cases with similar outcomes.

    Now, this is not to say that everyone with knee pain should get physical therapy instead of surgery. Sometimes, surgery is exactly what’s needed to improve your overall quality of life. However, including a physical therapist on your health care team – before and after surgery – is beneficial, even without changing the structural abnormalities that are often presumed to be the problem.

    If physical therapy isn’t changing the “structural problem,” what exactly is the benefit?

    People are more than pictures, and pain is far more complicated than what that picture shows. X-ray and MRI findings can absolutely be helpful in developing a plan of care; however, they are only one piece of the puzzle. While physical therapy is unlikely to result in a change in the X-ray or MRI findings, it can identify and help modify factors contributing to your knee pain and functional limitations.

    Focusing on your unique condition, a physical therapist can work with you to determine the following:

    • Health and lifestyle factors contributing to your knee pain
    • Activity modification so you can safely perform activities of daily living
    • Stretches and strategies to improve motion and strength
    • Swelling and pain control
    • How and when to appropriately get back to activities that cause you pain/discomfort

    This combination can help patients to better understand their condition and develop a plan that assists in recovery. Doing all of this may greatly enhance your quality of life and ease the pain and symptoms you are currently experiencing.

    Now, if you and your doctor determine that knee surgery is necessary, remember, physical therapy is a vital part of preparing for your procedure and recovering after it. Before surgery, we will work together to get you as healthy and strong as possible, which will enable your post-surgical recovery to be that much more successful and faster. Following surgery, we will focus on helping you to restore your strength, balance and flexibility.

    No matter what, physical therapists are committed to helping you be as mobile, independent and pain-free as possible. Our goal is to build a relationship in which you feel comfortable asking us questions, are an active partner in your care and we’re able to work together to ensure the best outcomes possible.

    If you have knee pain, contact us today and experience the power of physical therapy.

    References:

    1. Bhushan R. Deshpande, BS, Jeffrey N. Katz, MD, MSc, Daniel H. Solomon, MD, MPH, Edward H. Yelin, PhD, David J. Hunter, MBBS, PhD, Stephen P. Messier, PhD, Lisa G. Suter, MD, and Elena Losina, PhD. The number of persons with symptomatic knee osteoarthritis in the United States: Impact of race/ethnicity, age, sex, and obesity (2017)
    2. Horga, L.M., Hirschmann, A.C., Henckel, J. et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol (2020)

    By: Patrick Smith, P.T., DPT. Patrick is board-certified clinical specialist in sports physical and orthopedic physical therapy, a fellow of the American Academy of Orthopedic Manual Physical Therapists and a treating physical therapist with NovaCare Rehabilitation in Philadelphia, PA.

    Select Physical Therapy and NovaCare are part of the Select Medical Outpatient Division family of brands.

     


  • Posted on 10/18/2021

    Technology has brought many wonderful things to our fingertips. However, an undue side effect of all this technology and connectivity is a condition known as tech neck.

    If you have a stiff neck, experience headaches or feel frequent muscle tension around your neck and shoulders, your technology-using habits are likely a contributing factor. Physical therapy exercises can help to alleviate your pain.

    Many suffer unnecessary pain due to poor posture when using a computer, tablet or smartphone. Poor posture greatly increases the amount of pressure placed on your muscles. Sitting straight up, the weight of your head is 10-12 pounds. Slouching forward with head dropped down, the weight of your head is more like 50-60 pounds to your neck. It’s easy to understand why your muscles are hurting when you imagine them supporting five times more weight for several hours each day.

    If you’re suffering from tech neck, the good news is that it’s often reversible and treatable. Here are five strengthening and stretching exercises to combat it:

    Chin retraction

    You may often find yourself sitting slouched forward with your head well in front of your shoulders. This is the starting position for retracting your head.

    Pull your chin backward while looking directly forward. You should feel a “double-chin” forming under your jaw. Repeat this forward/backward exercise 10 times once every hour or two while working.

    Perform this daily while sitting at your work space.

    Trap stretch

    What about neck exercises for computer or laptop users? Tension in the upper trapezius muscles, which span the back of the neck and shoulders and are responsible for moving the head and shoulder blade, is common. The trap stretch can be performed any time, and you only need 20-30 seconds to help release tension on one side of your neck.

    To stretch the right side, place your right hand on your waist or lower back, tilt your head to the left while looking back to the right. Place your left hand on top of your head and gently pull toward the left until you feel a comfortable stretch. Hold this stretch for as long as 60 seconds and repeat on the other side.

    Perform this daily while sitting at your work space.

    Thoracic extension

    Lean forward in your chair as if you’re smashing a pillow between your belly and thighs. Place your hands with fingers crossed behind your head.

    Reach your elbows toward the ceiling while keeping your belly close to your thighs, causing only your upper back to straighten. The thoracic extension reverses the forward bend and slouchy posture so many assume throughout the workday.

    Perform this daily while sitting at your work space.

    Prone retraction

    Lie face down on the floor with your arms at your side, hands near the hips.

    Keep your neck straight (do not look upward) and simultaneously lift your chin, arms and knees off the ground. Hold the position for 2-3 seconds and release to the floor. Repeat 10 times for three sets.

    Perform this exercise  2-3 days each week to promote strengthening of the muscles across the back of your neck, shoulders and torso.

    Prone scaption

    Lie face down on the floor with your arms reaching upward and slightly outward from your head.

    Keep your neck straight and simultaneously lift your chin, arms and knees off the ground. Hold the position for 2-3 seconds and release to the floor. Repeat 10 times for three sets.

    This exercise emphasizes the lower trapezius muscle between your shoulder blades due to the overhead arm position. The prone scaption should be performed 2-3 days each week to promote strengthening of the muscles across the back of your neck, shoulders and torso.

    Finally, sit up straight. It’s not a complicated tip, but it is easy to forget that we need to maintain good posture when working with technology. Elevate your computer screen so that it is at eye level. If you’re working on a laptop, generally you’ll have to direct your gaze downward while keeping your posture upright, but do your best to comfortably elevate the computer. If you’re on a phone/tablet, simply make an effort to hold the device higher in front of your face.

    If you have pain that persists and is impacting your daily activities, contact us today to request an appointment with a licensed physical therapist. A physical therapy plan of care can efficiently and effectively strengthen your body, reduce pain and prevent injury.

    By: Joe Zucco, P.T., DPT, FAAOMPT, center manager for Select Physical Therapy in Sarasota, FL.

    Select Physical Therapy is part of the Select Medical Outpatient Division family of brands.

     


  • Posted on 10/1/2021

    At Select Physical Therapy, we believe movement is medicine. So, what moves you? Physical activity is key to good health, vitality, energy, strength and might even make you laugh more.

    If pain or a medical condition is holding you back, we’re here to help. Physical therapy is a moving experience.

    Physical therapy gets you back to life and the things that are most important to you. Whether it’s running a marathon, playing with the grandkids or simply cooking dinner pain-free, the benefits of physical therapy can change lives for the better.

    That’s why we’re excited it is October, one of our favorite months of the year. Why, you may ask? October is National Physical Therapy Month. For 31 days, we get to celebrate all things physical therapy and the many ways our dedicated physical therapists and physical therapist assistants help improve the quality of life.

    There is so much to share about the benefits of physical therapy, including the highly-trained clinicians who provide it. Did you know that physical therapy helps people manage pain and chronic conditions? How about the power of physical therapy to help heal from recent injury and reduce the risk of future injury? Or prepare the body for surgery and successful recovery or avoid the need for surgery altogether? Well, physical therapy does all this and more.

    Physical therapy is also a safe alternative to taking prescription medication. It treats common aches and strains, sprains and fractures, and helps with many other issues and conditions, including:

    • Back sprain/strain
    • COVID-19 fatigue and other debilitating illnesses
    • Headaches and concussions
    • Vertigo, dizziness and balance
    • Disc injury and pinched nerves
    • Rotator cuff tear, bursitis and frozen shoulder…and more

    So, what moves you? That marathon? Those grandkids? That culinary masterpiece? Whatever it is, physical therapy, and our compassionate team of licensed therapists, can help get you moving.

    Request an appointment today and see how physical therapy can physically, emotionally and mentally enrich your life.

    #ThePowerOfPhysicalTherapy #WhatMovesYou #ChoosePT

     


  • high school female volleyball team preparing

    Posted on 9/22/2021

    Sports and exercise are part of the lives of many young individuals. Typically, people who participate in sports are known to be healthier and less likely to partake in outside negative distractions compared to people who do not play sports. However, for some adolescent girls, when they only focus on the sport and not their bodies, consequences can arise. 
    Many girls who participate in sports are at risk for an issue called the female athlete triad. This triad consists of three conditions, and the athlete can have one, two or all three. The three conditions include disordered eating, amenorrhea and osteoporosis.

    Disordered eating

    Disordered eating is a term that refers to an individual having unhealthy eating behaviors and worrying about body image. Some of the most common forms of disordered eating include extreme dieting and restrictive eating. On the top end of the spectrum are eating disorders, which involve things such as self-induced vomiting, binge eating and laxative abuse. An individual can have disordered eating and not be diagnosed with an eating disorder. Most girls with disordered eating are trying to lose weight to help them improve their athletic performance. For these specific athletes, this eating pattern can range from not eating enough calories to sustain the amount of activity that they are participating in, to trying to avoid “bad” foods, all the way to eating disorders such as anorexia nervosa and bulimia nervosa.

    Amenorrhea

    Amenorrhea is the lack of menstruation, or one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as well as girls who have not started their periods by the age of 15. Intense exercise accompanied with not eating enough calories can lead to a decrease in the hormones needed for menstruation. As a result, a girl’s period may never come, become irregular or stop altogether. Some girls who have been participating in sports since a young age may never get their first period, because they have been training so hard. On the other hand, some girls may have gotten their period, but it disappears as their training intensifies or their eating habits change. On one hand, dysfunction of the menstrual cycle can lead to infertility. And on the other hand, it can lead to unplanned pregnancies in young women recovering from the triad. While the cycle is being restored, an egg may be dropped early and, without contraception, pregnancy can occur.

    Osteoporosis

    Osteoporosis is translated as porous bone. It is a disease in which the density and quality of the bone are reduced. For people with osteoporosis, boss loss overtakes the growth of new bone. Consequently, over time the bone becomes more porous and fragile, and the risk of fracture greatly increases. This typically happens silently, and there are usually no symptoms until the first fracture occurs. In girls with the triad, estrogen is typically lower. Low estrogen accompanied with a poor diet, especially low calcium, can lead to osteoporosis. During the teen years, a lot of bone growth is supposed to happen and the peak bone mass should be reached. An athlete with the female athlete triad will have a hard time getting to her peak bone mass, and it can affect her greatly later in life.

    Takeaway: Diagnosing and treatment

    Girls who have female athlete triad are typically invested in their sports and would do almost anything to be the best athlete possible. Girls in particular sports have more of a risk than others. Sports with a weight class like wrestling, martial arts and rowing, and sports where being thin is more optimal for performing like gymnastics, diving, figure skating, cross country and ballet, have a higher risk. However, the truth is, being very thin, and losing those last few pounds, doesn’t typically improve performance at all.

    If a female athlete is suspected to have the triad, a wide-ranging physical examination is needed for diagnosis. A doctor will likely ask questions about her period, diet, exercise habits and overall feelings about her body. From there, blood test will be ordered to check for vitamin deficiencies and to rule out any other reasons for a lack of period and weight loss. A doctor may also order a bone scan to check for osteoporosis, since the athlete will be at a higher risk for bone breaks.

    Doctors will not work alone to help treat a girl with female athlete triad. Coaches, athletic trainers, parents, physical therapists, nutritionists and dietitians and mental health specialists all work together and play a role in the recovery of this athlete. They focus on both the physical and emotional issues that the girl is likely facing to help prevent long term issues.

    References:

    By: Wyneisha Mason, MAT, ATC. ‘Neisha is an athletic trainer with RUSH Physical Therapy in Chicago, Illinois.

    RUSH and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.

     


  • illustration of glute medius and glute minimus

    Posted on 8/11/2021

    Recently, I had a runner try to increase their pace by 30 seconds from one weekend to the next. The result? Severe pain along the inside of their shin and the start of spending two days a week in physical therapy.

    Many running injuries are due to overuse and/or improper training. Up to 70% of recreational and competitive distance runners sustain an overuse running injury during any one-year period.1 One of my favorite questions to ask runners is, “Other than running, what exercises are you doing?” Usually the response is, “You mean running isn’t enough exercise?”

    Running injuries can be prevented. One of the keys to proper training is cross training. The most important group of muscles to strengthen for runners are those along the side of your hip, mainly your glute medius and glute minimus.

    When people hear glutes, they immediately think of their buttocks. But, two of the smaller glute muscles – the glute medius and minimus – are often overlooked. The glute medius and minimus are vital hip muscles and their main function is to stabilize your pelvis.

    When you’re walking, think about the moment you put your right foot down and swing your left leg through. Does your left hip drop down? If so, then you may have some weakness in these stabilizers along your right side. Now, imagine running more than five miles and this is repetitively happening without you knowing. Imagine the wear and tear this is taking on your body. Weak hips place unnecessary stress along your back, knees and feet. The good news is that this can be prevented.

    How do you strengthen your glutes? Here are some simple exercises that do not require much equipment.

    • Sidestepping: Place a resistance band just above your knees (easier) or above your ankles (harder). Keeping your toes pointing forward, side-step in a mini squat about 20 feet. Then, return to the start without turning around.
    • Jane Fondas: Lay on your left side completely against the wall, head, back and heels. Place a towel behind your right heel and keeping your toes pointing straight forward. Slowly lift your leg up/down. Repeat on other side.
    • Side planks: These can be done from your knees or feet.
    • Knee side plank: Slowly bring your buttocks back then forward to target multiple fibers of the muscle.
    • Hydrants: On all fours, lift your knee out to the side without letting your hips tilt.

    glute exercises

    For more information or to request a complimentary injury screen with one of our licensed physical therapists, please contact the center nearest you today. In the meantime, train smart, run fast and run happy!

    By: Sarah Zayyad, DPT, CMPT, CDNT, Cert-ART, physical therapist with RUSH Physical Therapy 

    RUSH Physical Therapy and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.

    1:  Ferber, R., Hreljac, A., & Kendall, K. D. (2009). Suspected Mechanisms in the Cause of Overuse Running Injuries: A Clinical Review. Sports Health: A Multidisciplinary Approach, 1(3), 242–246. https://doi.org/10.1177/1941738109334272 


  • Posted on 7/8/2021

    Select Medical, Select Physical Therapy's parent company, was proud to collaborate with the CDC on an important clinical study regarding the long-term impact of COVID-19. The study validates our Recovery and Reconditioning Program to focus on specific deficits in patients recovering from COVID-19 and other debilitating illnesses and conditions.

    Findings of the study indicate that patients recovering from COVID-19 could benefit from additional personalized rehabilitation services aimed at both physical and mental health. As the nation’s largest provider of outcomes-based, innovative physical therapy, Select Medical, along with Select Physical Therapy, is expertly positioned to guide the recovery of this 33.5 million patient population.

    The Recovery and Reconditioning program launched in June 2020 amid the pandemic and was developed in partnership with leading physicians, including physiatrists, pulmonologists, infectious disease specialists as well as physical and occupational therapists and speech-language pathologists. Following evidence-informed program guidelines, our licensed physical and occupational therapists tailor a plan of care to address patients’ specific needs and goals to resume pre-COVID activities and routine.

    Select Physical Therapy centers are “direct access” and do not require a physician referral to receive care. If you or a loved one are recovering from COVID-19, please click here to find a center near you and schedule an appointment today.

     


  • Posted on 6/28/2021

    Whether you’re new to the sport of triathlon or jumping back in after a longer break in racing, many are excited to drop any weight gained during the past year. It’s the perfect time of year to get outside and back to racing.

    While triathlons are a great way to push our bodies and are relatively safe for individuals at any age, athletic background or ability level, participants also need to be aware of the:

    • Pitfalls of overtraining
    • Importance of rest
    • Appropriate time to take some time off

    What defines rest and why is it important?

    Rest comes in many forms. It can be as simple as the time between repetitions, intervals or sets or a scheduled day off in your training plan. And, it can be skipping a workout when you are tired and feeling worn down, physically or mentally.

    If you sustain an injury or have an illness, rest may mean prolonged time away. However, rest doesn’t mean you have to completely stop all activity. You can take time off from typical training to work on mobility, participate in a yoga class, go for a walk, spend extra time on nutrition or enjoy a hot bath and relax.

    Whether planned or forced, rest allows the body to adapt to the stressors and changes in demand being placed on it. It allows muscles to recover and gain strength, our nervous system to adapt to changes and regenerate and our body to replenish our energy stores. Rest ultimately decreases the risk of overtraining, overtraining syndrome and overuse injuries.

    Triathlon training naturally allows our muscle groups to get some rest. When training in one discipline, the muscles involved in the other disciplines naturally get some time off. Spending the day in the pool gives your body a break from the repetitive pounding on the pavement from running, and with cycling or spinning, your shoulders get some needed time off from the resistance of the water.

    When is it time to take off, skip a workout and push training to another day?

    What are the signs of needing a break?

    As you dive into your training plan and are weeks out from the year’s first event, here are some important signs and symptoms that your body is telling you to take a break:

    • You are suffering through workouts that were previously done with ease
    • Notice your form is deteriorating or you are slower in any of your disciplines
    • It is harder to wake up
    • Increased irritability
    • Decreased motivation to train or in your daily life
    • Decreased concentration during work-outs
    • Increased sleeping
    • More frequent soreness or injuries (and it’s not due to an increase in intensity level of working out)
    • Increased illness

    If we don’t listen to these signs, our bodies may just force us to rest. If this happens, we can end up overtraining or sidelined with an injury.

    What is overtraining?

    Overtraining, simply put, is doing more than your body can handle at any given time. There is an imbalance between training, nutrition and rest leading to a decrease in performance, increase in fatigue and a decline in mood. For a well-trained athlete, overtraining may occur when putting in extra training sessions on an already full schedule. If you’re a rookie, it might mean jumping in too quickly with one or two extra days of training.

    Overtraining can be influenced by outside workload when we are stretching our personal schedules and sleep routines too thin. You may see you are underperforming with little to no change in your training program. Or, you may find you have more difficulty sleeping - falling asleep or staying asleep despite fatigue from working out.

    Once this stage or overtraining is reached, athletes will often find an elevated heart rate, especially first thing in the morning as well as deficiencies in vitamins B12 or D, lower iron levels and increase in creatine kinase levels in the blood. All of these can be serious signs of overtraining syndrome and can force an athlete into three-to-eight weeks off from training and treatment by a medical professional.

    What are overuse injuries?

    The most common overuse injuries in triathletes and athletes in general are from overtraining or overuse. Overuse injuries represent the largest percentage of sports-related injuries that require medical attention and are most common in runners and endurance athletes (triathletes).

    Approximately 50-70% of triathlete injuries occur when running, and the majority of those are overuse. These injuries most often occur in the knee, Achilles, foot or back or the shoulder from swimming. They can occur due to a breakdown in tissue that doesn’t have adequate time to repair itself before more use.

    If you are seeing aches and pains that don’t subside in approximately three days in the well-trained athlete or seven days in a new participant (due to new muscles being trained,) it is time to take some time off and seek out your local physical therapist for guidance. A physical therapy plan of care can help you heal, regain/increase strength and flexibility and reduce pain. It can also help you prevent future injury and optimize your sports performance.

    Author: Melissa Bryant, P.T. Melissa serves as the center manager for Select Physical Therapy’s Colorado Springs facility, located in the USA Triathlon headquarters building.

    Select Physical Therapy is part of the Select Medical Outpatient Division family of brands.

    Resources

    • Vleck, V., & Alves, F. B. (2011). TRiathlon injury review. British journal of sports medicine, 45(4), 382-383.
    • Koutedakis, Y., Budgett, R., & Faulmann, L. (1990). Rest in underperforming elite competitors. British Journal of Sports Medicine, 24(4), 248-252.
    • Gosling, C. M., Forbes, A. B., McGivern, J., & Gabbe, B. J. (2010). A profile of injuries in athletes seeking treatment during a triathlon race series. The American journal of sports medicine, 38(5), 1007-1014.
    • Budgett, R. (1990). Overtraining syndrome. British journal of sports medicine, 24(4), 231-236.
    • O'Toole, M. L., Hiller, W. D. B., Smith, R. A., & Sisk, T. D. (1989). Overuse injuries in ultraendurance triathietes. The American journal of sports medicine, 17(4), 514-518.
    • Collins, K., Wagner, M., Peterson, K., & Storey, M. (1989). Overuse injuries in triathletes: a study of the 1986 Seafair Triathlon. The American journal of sports medicine, 17(5), 675-680. 

     


  • Close up of female hand while playing the piano

    Posted on 6/9/2021

    The first week of June has been annually designated by the American Society of Hand Therapists as Hand Therapy Week. It’s a time for raising awareness of hand, wrist, arm, elbow and shoulder injuries and conditions and the therapists who have specialized training to treat them. This week is also a great time to spotlight the individuals who most benefit from hand therapy, individuals like musicians.

    Playing a musical instrument is emotionally, mentally and physically demanding. Musicians, like athletes, are at risk for career-ending injuries in the neck, shoulder, wrist and hand. In a musicians’ lifetime, 63-93% will experience musculoskeletal symptoms related to their instrument play. Even the most conscientious musician can begin with symptoms or injury at various times through their play and performance season.

    The challenges musicians face are practice and rehearsal patterns established by others (an orchestra conductor, for example) in large segments of time, without rest or stretch breaks. There is also fierce competition for work, and musicians may be reluctant to complain of injury or new symptoms for fear of losing out on an opportunity. Additional injury risk factors include inadequate physical conditioning, poor posture, abrupt increase in play time and patterns, poor techniques or a change in the instrument.

    Symptoms, whether intermittent or persistent, are seen most often when learning to play over the age of 50. In professional musicians, symptoms can present when increasing the complexity or time spent playing.

    Common symptoms include:

    • Pain
    • Muscle cramping
    • Tremors/spasms
    • Inability to control motion
    • Headaches
    • Numbness/tingling
    • Stuck, catching or locking joints
    • Inability to straighten fingers

    Hand therapists have the important skills needed to evaluate musicians and identify abnormal sensation, poor posture and other causes of symptoms.

    A therapist identifies risk factors and develops a rehabilitation program specific to the musician’s instrument, goals and play demand. The plan may start with an active rest period, avoiding activities that cause symptoms while mentally rehearsing and initiating new normal movement patterns. During this stage, the therapist modifies the play/practice schedule and explores pain control techniques and strategies including diet, exercise, sleep and posture.

    When the active symptoms quiet down, the hand therapist begins the advanced rehabilitation phase with a goal to return to play. The therapist monitors play and rest cycle and a home program is developed to provide visual feedback using imagery and mirrors. The advanced rehabilitation phase also involves aerobics and fitness, strengthening, postural exercises and increased duration and complexity of play.

    The hand therapist works with the musician to develop a return to normal play schedule that is timed incrementally. The schedule starts with a slow and easy repertoire and passages, increasing to fast and more challenging passages for up to 10 minutes. Activities that help with return to play include warm-up with brisk walking, cycling and stretching.

    The musician will warm-up with their instrument using easy scales, long movements, slow and quiet play. As rehabilitation progresses, 50 minutes is generally the maximum play time before rest is suggested. The therapist also instructs the musician on symptom management techniques during rest and after play. These management techniques include ice, hydration and stretching.

    Hand therapists identify the root cause of injury, provide a whole-body approach to care and work in collaboration with music instructors to ensure continuity with proper technique and posture. Education and early intervention is key, as early treatment leads to better outcomes.

    If you or a loved one are a musician and suffering from pain or discomfort while playing, request an appointment today and experience the power of hand therapy. Our certified hand therapists will help you get back to doing what you love – creating beautiful music!

    By: Rob McClellan, OTR/L, CHT. Rob serves as the hand program coordinator for Physio.

    Physio and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands. 

     

     


  • woman wearing covid protection mask

    Posted on 5/25/2021

    Have you ever heard the term “mask jaw”? Well, guess what? With a year-plus of everyone wearing masks to protect from covid, it's a thing!

    Mask jaw is the jaw pain and pressure many of us experience as we wear our masks for an extended period of time since the start of the COVID-19 pandemic. Now, while the Centers for Disease Control and Prevention recently put out new masking guidance for vaccinated people, masks will still be part of most of our lives for the foreseeable future. And, all that mask wearing can take a toll!

    If you jut your chin forward or tense your jaw muscles to hold your mask in its proper position over your nose and mouth, you are likely experiencing jaw tightness. Headaches and muscle tension can also be caused by stress, something we’ve all felt more of since March 2020!

    Let’s take a closer look at how your jaw works. Your jaw bone connects to your skull on both sides of your face, and is referred to as the temporomandibular joint, or TMJ. It is a rounded bone, with a disc that provides a cushion to support the joint, much like the discs in your spine and meniscus in your knee.

    When you first open your mouth, your jaw hinges and rotates. As you open further, it glides and translates until you open it fully. This action happens with large muscles from your temples and cheek, to smaller muscles deep within the jaw. At least that’s how it works normally. When there is an issue with the disc, the muscles or the joint itself, it is referred to as temporomandibular joint dysfunction, or TMD.

    TMD includes a wide range of symptoms, such as pain in the jaw or neck, headaches, locking of the jaw in an open or closed position, clicking noises and pain or difficulty with speaking, eating or chewing. TMD symptoms are widely reported by many people, but become troublesome when they start limiting your day-to-day activities.

    Now, let’s dive into how your mask may be the culprit to any lingering jaw pain you may be experiencing.

    1. Maybe you are breathing through your mouth while wearing your mask. Did you know that this places more stress on the jaw from it being constantly open?

      Wearing a mask can feel like you are not getting enough fresh air, but it should not alter how you breathe. Each inhale and exhale should pass in and out of your nose. Your jaw muscles are relaxed in this “resting” position. This means that the tip of your tongue is gently touching the roof of your mouth while your back teeth, the molars, are not quite touching.  

      If you breathe in and out of your mouth, your jaw remains open. To keep your jaw open means your muscles are doing extra work. When you breathe with a mask on, focus on the air passing in and out of your nose.
    2. Maybe the ear loops are too tight. This creates tension and can throw off the alignment of your jaw and, in some cases, cause headache. 

      Masks come in all shapes and sizes, and the fit is important. Whether made of fabric or disposable, it should never feel like it is pulling your ears forward or your chin backward. These compressive forces can easily trigger a headache. Consider a mask extender or “ear savers” to keep the ear loops from tugging and avoid a potential headache altogether.
    3. Are you clenching your teeth more because of stress? This is an easy trigger for TMJ pain and dysfunction. 

      Remember the resting jaw position? This is the most relaxed position for the muscles. When you clench your teeth and hold that bite position for extended periods of time, the jaw muscles can go into spasm. Avoid gum chewing or biting your nails, which can make symptoms worse. Exercise is a key component to overall health and managing stress. Take a walk or jog, meditate or find another way to get moving. Your body and your jaw will thank you.
    4. Chances are, you are moving your jaw in altered positions to adjust how your mask is resting on your face. 

      With a proper fitting mask, you will avoid overusing your jaw. Use a mask that has some moldable wire that can be shaped around your nose. Additionally, avoid masks that are too big and sag on your face, or that are too small and tug on your ears. You should be able to speak and breath through your mouth (wink, wink) comfortably. To avoid jaw pain, make sure your mask is molded to your face and does not slide or move easily.  

      If you are feeling pain or clenching in your jaw, experiencing headaches or are having difficulty with chewing or eating, physical therapy can help. To learn more about our TMD program or to schedule an appointment at one of our centers, please contact us today.

      By: Nicole Romaine, P.T., MPT. Nicole is a physical therapist for Kessler Rehabilitation Center in West Orange, NJ. 

      Kessler and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.